Immediate skin-to-skin contact and exclusive breastfeeding increases a premature baby’s chances of survival, a study has found.
Researchers at Karolinska Institutet, co-ordinated by the World Health Organization (WHO), found that starting what is known as ‘kangaroo mother care’ straight after birth has the potential to save the lives of up to 150,000 more premature babies each year, compared with current recommendations.
WHO advice for pre-term babies
Currently, WHO suggests starting kangaroo mother care only once the baby is stabilised in an incubator or warmer, which can take on average three to seven days.
Nils Bergman, doctor and researcher at the Department of Women’s and Children’s Health, Karolinska Institutet, Sweden, and one of the initiators of the study, said: “The idea of giving skin-to-skin contact immediately after delivery to very small, unstable babies has encountered quite strong resistance, but about 75% of deaths occur before the infant has been judged sufficiently stable.”
The clinical trial was conducted at five university hospitals in Ghana, India, Malawi, Nigeria, and Tanzania, where mortality for these babies, prior to the study, varied from 20 to 30%. The results of the study were published in The New England Journal of Medicine.
In the study, 3,211 infants were randomly assigned to two groups – one that received immediate kangaroo mother care (iKMC) and continued skin-to-skin contact at the neonatal unit, where the mothers also received their medical care, and a control group that received standard care, whereby mothers and babies are cared for in separate units and were only reunited during infant feeding.
As soon as the babies had stabilised sufficiently, mothers and babies from both groups were transferred to the regular kangaroo mother care unit. During the first 72 hours, the infants in the iKMC group received approximately 17 hours of skin-to-skin contact per day, compared with 1.5 hours in the control group.
Dr Rajiv Bahl, Head of the Newborn Unit at WHO, and the co-ordinator of the study, said: “Keeping the mother and baby together right from birth with zero separation will revolutionise the way neonatal intensive care is practiced for babies born early or small.
“When started at the soonest possible time, kangaroo mother care can save more lives, improve health outcomes for babies and ensures the constant presence of the mother with her sick baby.”
Mortality during the first 28 days was 12% in the iKMC group compared to 15.7% in the control group, which corresponds to a reduction of 25%. There were also significantly fewer babies in the iKMC group with a low body temperature or bacterial blood poisoning.
The results of the study indicate the need for a global paradigm shift in the care of small babies with zero separation of babies from their mothers by having dedicated Mother-Newborn ICUs.
Immediate kangaroo mother care had several other benefits in addition to improved survival. It reduced infections and hypothermia, which are two big killers of small babies. The babies also had more opportunity to breastfeed.
Dr Harish Chellani, one of the study investigators, from Vardhman Mahavir Medical College and Safdarjung Hospital, India, observed: “Healthcare providers have been separating small and sick babies from their mothers for decades believing that was best for them. The new evidence from this study means we must establish the practice of immediate kangaroo mother care globally.”
WHO is in the process of reviewing its current recommendations on kangaroo mother care, published in 2015, based on this new evidence.